People denied entitlement to continuing healthcare because of assessment backlog, experts warn

People are being denied their entitlement to continuing healthcare, as a result of the ongoing backlog in cases arising from last year’s six-month suspension of assessments, experts have warned

The pressure to clear backlogs is leading to unfair decisions and some areas are using localised discharge forms, instead of the national CHC checklist, in a way that is wrongly screening people out of consideration for CHC funding, a specialist lawyer and a CHC consultant have said.

The data also shows the total number of people receiving CHC and NHS-funded nursing care is starting to recover after a big drop in April to June 2020, but is not back up to pre-pandemic levels. In January to March 2020, 54,102 people were eligible for CHC, with 49,932 eligible in the latest quarter, up from 46,760 in July to September last year.

‘Backlog considerable’

Dan Harbour, managing director of CHC advice organisation Beacon, said that while clinical commissioning groups officially recommenced assessments in September, it had been a “gradual re-start” depending on the ability of local teams to bring back and retrain deployed staff.

“The backlog is considerable so it is no surprise that it has not yet been cleared; this will take some months more and we are likely to see a lot of regional variation.

“Although there has not been a further closure of CHC services, we know that a number of London CCGs stopped assessments again in Jan/Feb,” Harbour said.

Furthermore, he said the overwhelming majority of assessments  Beacon had seen since they resumed were for people who received Covid-19 or discharge funding for their post-discharge care during the pandemic.

“This means there will be plenty of people in the community paying for their own care whose assessment has been delayed for months, hence the growth in delays of over 26 weeks.

“I wouldn’t expect eligibility rates to return to pre-Covid levels until the end of this year realistically,” he said.

Acting contrary to CHC regulations

Harbour also raised concerns about the way in which assessments were being carried out.

“It is a very mixed picture nationally with some good practice and some very poor assessments paying scant regard to national procedures.

“We are also very concerned about the plethora of localised discharge forms which some areas are using instead of CHC checklists to screen people out of consideration for CHC funding. We believe this to be unlawful but it is on the rise,” Harbour said.

CHC regulations state that the only screening tool that can be used is the national checklist tool, published under the CHC national framework.

“We are seeing a whole range of new forms from around the country developed by local area teams, which require the assessor to go into detail about the individual’s care needs and in some cases clearly apply a higher criteria than is found in the checklist itself.”

This means people are being screened out of the CHC assessment process by a form that is not approved nationally and actually raises the bar higher than the checklist threshold, he added.

“That means unauthorised one-person assessments are determining whether people have a primary health need, without the right paperwork, no multidisciplinary team, no input from the individual’s representatives and no accountability.”

‘Unfair decisions’

Lisa Morgan, a partner at law firm Hugh James who specialises in CHC, said the pressure on clearing backlogs was leading to unfair decisions.

“We have seen an increase in the number of people approaching us who have recently had assessments, which have removed NHS funding, I fear the pressure on clearing the backlogs has lead to unfair decisions.

“This is forcing families to embark through the onerous appeal process during this difficult time, which will eventually lead to the NHS paying redress in the form of the care home fees paid plus interest,” Morgan said.

Lou Patten, chief executive of NHS Clinical Commissioners, the  membership organisation for clinical commissioning groups, said since assessments restarted in September, CCG CHC teams had worked incredibly hard to address the backlog.

“In order to reduce the number of people in care homes and minimise the risk of Covid infection, CHC teams are having to use a variety of methods to undertake these assessments, including conference calls or video calls.

“CHC assessments should involve the patient and their families, where appropriate, as well as health and care professionals, and I would urge CHC assessors to ensure this happens in their areas.”